SEVENTY-FIRST WORLD HEALTH ASSEMBLY A71/41 Provisional agenda item 20.3 29 March 2018

Progress reports

Report by the Director-General

CONTENTS

Communicable diseases

A. Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections,

for the period 2016–2021 (resolution WHA69.22 (2016)) .................................................... 3

B. Eradication of dracunculiasis (resolution WHA64.16 (2011)) ............................................. 5

C. Elimination of schistosomiasis (resolution WHA65.21 (2012)) ........................................... 6

Noncommunicable diseases

D. Public health dimension of the world drug problem (decision WHA70(18) (2017)) ........... 7

E. Global burden of epilepsy and the need for coordinated action at the country level to

address its health, social and public knowledge implications (resolution WHA68.20 (2015)) 9

F. Comprehensive mental health action plan 2013–2020 (resolution WHA66.8 (2013)) ......... 10

G. Comprehensive and coordinated efforts for the management of autism spectrum

disorders (resolution WHA67.8 (2014)) ............................................................................... 11

Promoting health through the life course

H. Global strategy and action plan on ageing and health 2016–2020: towards a world in

which everyone can live a long and healthy life (resolution WHA69.3 (2016)) .................. 13

Health systems

I. Promoting the health of refugees and migrants (resolution WHA70.15 (2017)) .................. 14

J. Strengthening integrated, people-centred health services (resolution WHA69.24 (2016)) .. 16

K. Promoting innovation and access to quality, safe, efficacious and affordable medicines

for children (resolution WHA69.20 (2016)) ......................................................................... 17

A71/41

2

L. Sustainable health financing structures and universal coverage

(resolution WHA64.9 (2011)) ............................................................................................... 18

M. Availability, safety and quality of blood products (resolution WHA63.12 (2010)) .............. 20

N. Human organ and tissue transplantation (resolution WHA63.22 (2010)) ............................. 21

O. WHO strategy on research for health (resolution WHA63.21 (2010)) ................................. 23

P. Workers’ health: global plan of action (resolution WHA60.26 (2007)) ............................... 24

Health emergencies programme

Q. Smallpox eradication: destruction of variola virus stocks (resolution WHA60.1 (2007)) .... 27

Corporate services/enabling functions

R. Multilingualism: implementation of action plan (resolution WHA61.12 (2008)) ................ 28

A71/41

3

Communicable diseases

A. GLOBAL HEALTH SECTOR STRATEGIES ON HIV, VIRAL HEPATITIS AND

SEXUALLY TRANSMITTED INFECTIONS, FOR THE PERIOD 2016–2021

(resolution WHA69.22 (2016))

1. In May 2016, the Sixty-ninth World Health Assembly, in resolution WHA69.22, adopted the

global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections,

for the period 2016–2021. This report describes the progress achieved in implementing the strategies.

2. The regional committees responded proactively, variously endorsing, adapting and promoting

the strategies, including through regional action plans.

3. The strategies promote synergies across the diseases and other health areas. A number of

advances have been made, including: participation of 60 countries in the Global Antimicrobial

Resistance Surveillance System and publication of guidelines and a global action plan on HIV drug

resistance; validation of the elimination of mother-to-child transmission of HIV and/or syphilis in

10 countries or areas in 2016 and 20171 and endorsement by the Regional Committee for the Western

Pacific of a regional framework for the triple elimination of mother-to-child transmission of HIV,

hepatitis B and syphilis in Asia and the Pacific 2018–2030;2 publication of new treatment guidance for

HIV infection, hepatitis C, syphilis, Chlamydia trachomatis infection, genital herpes and gonorrhoea;

publication of advice on the use of a dual HIV/syphilis rapid diagnostic test in antenatal services; and

updating of the WHO Model List of Essential Medicines3 to include new treatments for sexually

transmitted infections, the first combination therapy effective against all six genotypes of hepatitis C

virus, and antiretroviral drugs for use as pre-exposure prophylaxis to prevent HIV infection.

4. Under the strategies’ framework, key partnerships have been strengthened resulting in: the

signing of a Memorandum of Understanding between WHO and the Global Fund to Fight AIDS,

Tuberculosis and Malaria to improve country impact of the Fund’s investments; the signing of a

Memorandum of Understanding between WHO and UNODC that makes a commitment to joint action

on HIV, viral hepatitis and tuberculosis among people who use drugs; co-signature of a joint United

Nations statement on ending discrimination in health care settings; joint advocacy with the World

Hepatitis Alliance to drive action to tackle viral hepatitis; and award signing of a grant from Unitaid to

WHO to promote research and innovation in HIV and hepatitis C prevention, diagnosis and treatment.

5. HIV infection. Treatment scale-up has continued rapidly, with 20.9 million people receiving

treatment by mid-2017, compared with 19.5 million in 2016. Progress towards the

UNAIDS “90-90-90” target for HIV testing and treatment has been guided by new WHO policies and

guidelines, including those on: the use of antiretroviral drugs for treatment and prevention; patient

monitoring and case surveillance; HIV-related drug resistance; key populations; HIV self-testing and

1 Armenia, for HIV only (2016); Republic of Moldova, for syphilis only (2016); dual elimination in Belarus and

Thailand (2016) and Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts and

Nevis (2017).

2 See resolution WPR/RC68.R2 (2017).

3 The selection and use of essential medicines: report of the WHO Expert Committee, 2017 (including the 20th WHO

Model List of Essential Medicines and the 6th WHO Model List of Essential Medicines for Children). Geneva: World Health

Organization; 2017 (WHO Technical Report Series, No. 1006;

http://www.who.int/medicines/publications/essentialmedicines/trs-1006-2017/en/, accessed 5 March 2018).

A71/41

4

partner notification; managing advanced HIV disease; and sexual and reproductive health and rights of

women living with HIV. Monitoring the uptake and implementation of WHO guidance is now routine

and has demonstrated country impact: by November 2017, 70% of 139 low- and middle-income

countries were following HIV “treat all” guidance, 58% had fully implemented routine viral load

testing, 40% had included dolutegravir in first-line antiretroviral therapy combinations and 27% had

either implemented or were developing a policy on HIV self-testing.

6. Viral hepatitis. In 2017, WHO published the first global hepatitis report, describing the

epidemiological situation and response to viral hepatitis. The global health sector strategy on viral

hepatitis 2016–2021 has stimulated country action, particularly in the areas of national strategic

planning and scale-up of treatment. In 2017, 82 countries reported that viral hepatitis plans were in

place, compared with only 17 in 2012, yet only 35% of these countries reported dedicated funding for

such plans. The number of persons starting hepatitis C treatment increased from 1.1 million in 2015 to

1.76 million in 2016, with most (86%) receiving direct-acting antiviral medicines, with the increase

spurred by decreasing prices of these medicines. The price of a course of sofosbuvir to cure

hepatitis C, for example, decreased in some countries from about US$ 84 000 to less than US$ 200

between 2014 and 2017. For hepatitis B, the number of persons on lifelong treatment increased from

1.7 million in 2015 to 4.5 million people in 2016, representing an increase in coverage from 8% to

16%. Between 2004 and 2017, the annual cost of treatment with tenofovir for hepatitis B decreased

from US$ 208 to US$ 28. In 2018, as patents expire, all countries should be able to procure generic

tenofovir, further increasing access to hepatitis B treatment. Progress in countries has been facilitated

by increased political commitments. The World Hepatitis Summit in November 2017 brought together

public health professionals, governments and civil society, resulting in a declaration supporting the

elimination of hepatitis as a public health threat.

7. Sexually transmitted infections. The global health sector strategy on sexually transmitted

infections 2016–2021 identified global targets for 2030 and progress has been made in the generation

of global baseline incidence data. Provisional estimates, derived from the Spectrum-STI modelling

tool and based on reported data from 129 countries, suggest that in 2016 there were 1.1 million global

maternal syphilis cases resulting in more than 660 000 cases of congenital syphilis, with 350 000 of

these occurring as adverse birth outcomes. In 2017, five countries developed baseline incidence data

for Neisseria gonorrhoeae and Chlamydia trachomatis infections and a further seven will develop

estimates in 2018. Human papillomavirus vaccine for girls was introduced into 71 national

immunization programmes by March 2017. The global health sector strategy was promoted and

discussed in six regional meetings attended by 105 Member States, the majority of which reported use

of the strategy and new treatment guidelines. The development of guidelines on syndromic

management of sexually transmitted infections started in 2017, with publication planned in 2018. A

survey is planned for 2019 to measure progress towards the achievement of 2020 milestones. Research

on new diagnostic tests and vaccines for sexually transmitted infections has advanced, with an

independent laboratory-based evaluation of promising point-of-care tests completed and new treatment

options for syphilis and gonorrhoea being explored.

8. Despite considerable progress, meeting the 2020 milestones of the three global health sector

strategies requires strengthening approaches to reach populations and locations with the highest

incidence and poorest prevention and treatment outcomes. The draft thirteenth general programme of

work, 2019–2023 provides new opportunities to enhance implementation and impact of the strategies.

A71/41

5

B. ERADICATION OF DRACUNCULIASIS (resolution WHA64.16 (2011))

9. In 2017, only two countries, Chad and Ethiopia, reported human cases of dracunculiasis:

previously the disease was endemic in 21 countries.1 The number of human cases fell from an

estimated 3.5 million in 1986 to only 30 in 2017: Chad and Ethiopia reported 15 human cases each,

from a total of 20 villages. In 2017, for the first time, South Sudan reported zero human cases; Mali

reported zero human cases in both 2016 and 2017. The reduction in the risk of dracunculiasis in

marginalized communities helps in the attainment of universal health coverage.

10. WHO, its global partners (The Carter Center, UNICEF and the WHO Collaborating Center for

Dracunculiasis Eradication at the United States Centers for Disease Control and Prevention), as well

as other stakeholders have continued to work hard to ensure that support is provided for dracunculiasis

eradication efforts, wherever needed.

11. Following recommendations of the International Commission for the Certification of

Dracunculiasis Eradication, WHO has certified a total of 199 countries, territories and areas, including

187 WHO Member States, as free from dracunculiasis transmission, the latest being Kenya, in

February 2018. Seven Member States remain to be certified: Chad, Ethiopia and Mali, in which the

disease is currently endemic; South Sudan and Sudan, in the pre-certification stage; and Angola and

the Democratic Republic of the Congo, which have had no history of the disease since the 1980s.

12. During 2017, the four countries in which the disease was endemic (Chad, Ethiopia, Mali and

South Sudan) sustained active community-based surveillance in 6547 villages, compared with

5300 villages in 2016. Nationwide communication campaigns were launched by each of these

countries during 2017.

13. In 2017, no human cases or infected animal were found following searches in Angola (in

two thirds of the country) and in the Democratic Republic of the Congo (in 18 of the country’s

26 provinces).

14. All countries that remain to be certified, except Angola, continue to offer cash rewards for

voluntary case reporting. A global reward scheme, similar to that used in the last stage of the smallpox

eradication campaign, is being planned by the Secretariat in consultation with Member States. Nearly

40 800 rumours of cases of dracunculiasis were reported globally and investigated during 2017:

19 rumours led to the detection of human cases in Chad and Ethiopia. The majority of

post-certification countries in which the disease was previously endemic (11/15) continued to submit

quarterly reports to WHO in 2017.

15. Dracunculus medinensis infection in dogs remains a challenge to the global dracunculiasis

eradication campaign. In 2017, Chad reported 817 infected dogs; 11 infected dogs and four infected

baboons were reported by Ethiopia, and nine infected dogs by Mali. In Chad, the number of infected

dogs fell by 26% and the number of D. medinensis worms emerging from infected dogs by 38%

during 2017. Results of operational research indicate that transmission can be interrupted through the

application of current strategies, including vigorous pursuit of copepod control and the prevention of

transmission from human cases and infected dogs.

1 Prior to South Sudan’s independence in 2011, the disease was endemic in 20 countries.

A71/41

6

16. Insecurity and inaccessibility due to conflicts continue to hinder accessibility and eradication

programme efforts in certain areas. In Mali, security concerns in the regions of Gao, Kidal, Mopti and

Ségou remain a hurdle to programme implementation. Civil unrest, including cattle raids, and massive

population displacement in South Sudan continue to hamper programme implementation and restrict

access to areas in which the disease is endemic.

17. The Director-General regularly monitors the eradication campaign. An annual meeting of all

national dracunculiasis eradication programmes is held in which countries officially report on the

status of their programmes during the preceding year.

18. An informal meeting with health ministers of countries affected by dracunculiasis, chaired by

the Regional Director for Africa, was held on the margins of the Seventieth World Health Assembly

in 2017. The ministers and their representatives expressed their continued commitment to lead in

advocating for and supporting their national eradication programmes, and pledged to redouble efforts

to interrupt transmission of the disease as soon as possible.

C. ELIMINATION OF SCHISTOSOMIASIS (resolution WHA65.21 (2012))

19. Schistosomiasis remains a significant global public health problem. The main intervention is the

periodic administration of the anthelmintic medicine, praziquantel. Increased availability of donated

praziquantel allowed some 89.2 million people, particularly school-age children, to be treated in

39 countries in 2016. Although donation of praziquantel from the pharmaceutical industry had

increased from 72.3 million tablets in 2014 to 183 million tablets in 2016, these donations still covered

only about 30% of the 563 million tablets needed. Some 206.4 million people required preventive

chemotherapy for schistosomiasis in 2016; coverage for school-age children was 53.7%.

African Region

20. Of the 41 Member States in the Region, 31 reported data in 2016, according to which, some

82.1 million people received preventive chemotherapy. In 19 countries, coverage reached 100 % of

endemic areas. A total of 57.4 million school-age children were treated, representing 57.2% coverage.

The WHO target of 75% coverage for school-age children was met in Burkina Faso, Burundi,

Cameroon, Côte d’Ivoire, Guinea, Mali, Malawi, Mozambique, Swaziland, Togo, United Republic of

Tanzania and Zimbabwe. The number of people receiving preventive chemotherapy for

schistosomiasis increased by nearly 57%, from 52.4 million in 2014 to 82.1 million in 2016.

21. The introduction of preventive chemotherapy through mass treatment campaigns has led to a

significant decrease in schistosomiasis prevalence in sub-Saharan Africa from 15.4% in 2010 to 7.7%

in 2017. The number of people requiring preventive chemotherapy for schistosomiasis decreased from

258.8 million in 2014 to 206.4 million in 2016.

Region of the Americas

22. Preventive chemotherapy is required in the Bolivarian Republic of Venezuela and Brazil, with

1.6 million people in need of treatment. In 2016, only Brazil reported having used a test-and-treat

strategy, with which it had treated 16 054 people. Suriname has residual transmission in isolated foci,

while transmission may have been interrupted in seven other countries or territories: Antigua and

Barbuda, Dominican Republic, Guadeloupe, Martinique, Montserrat, Puerto Rico and Saint Lucia.

A71/41

7

South-East Asia Region

23. Indonesia is the only Member State in the Region with populations requiring preventive

chemotherapy. These populations reside in 28 villages of Central Sulawesi, where prevalence of

infection in humans is less than 2%. In 2016, 5319 people were treated. In 2017 a comprehensive

national plan of action was launched.

European Region

24. The occurrence of autochthonous cases of schistosomiasis due to Schistosoma haematobium in

Corsica (France) between 2011 and 2015 highlights the need for vigilance in areas of Southern Europe

where the intermediate host snail is present. The situation has been under control since 2015, with no

new autochthonous cases reported.

Eastern Mediterranean Region

25. Four Member States in the Region (Egypt, Somalia, Sudan and Yemen) have populations

requiring preventive chemotherapy. Preventive chemotherapy was used for the first time in Somalia in

2017. In 2016, Egypt, Sudan and Yemen reported treating 5.6 million people of whom 60% were

adults. The number of people treated in the Region decreased from 7.8 million in 2014 to 5.6 million

in 2016, mainly due to the impact of years of political instability on treatment rates in Yemen. Of all

the cases treated in the Region, 60.3% were in Sudan. In 2017, surveys were conducted in Oman and

Iraq to confirm the interruption of schistosomiasis transmission.

Western Pacific Region

26. In 2016, some 3.2 million people required preventive chemotherapy in four Member States in

the Region (Cambodia, China, Lao People’s Democratic Republic and Philippines), although

schistosomiasis cases are restricted to certain communities in those countries. Reports on

schistosomiasis treatment were received from Cambodia, Lao People’s Democratic Republic and the

Philippines in 2016; more than 1.5 million people were treated. Schistosomiasis prevalence in humans

has been reduced to very low levels in many endemic areas, meaning that transmission may be

interrupted soon. Zoonotic transmission, however, particularly through S. japonicum, remains an issue.

27. The Secretariat is using new evidence to draft guidelines on the implementation of

schistosomiasis control and elimination, and on the verification of the interruption of the transmission.

Furthermore, snail control has been integrated in the Global vector control response 2017–2030.

Guidance has been issued on the use of a novel diagnostic test for S. mansoni, which is more

appropriate for low-transmission areas.

Noncommunicable diseases

D. PUBLIC HEALTH DIMENSION OF THE WORLD DRUG PROBLEM (decision

WHA70(18) (2017))

28. The Seventieth World Health Assembly, in decision WHA70(18), requested that the

Director-General continue efforts to improve WHO’s coordination and collaboration with the United

Nations Office on Drugs and Crime (UNODC) and the International Narcotics Control Board (INCB)

A71/41

8

in addressing and countering the world drug problem, and to continue to keep the Commission on

Narcotic Drugs (CND) appropriately informed of relevant programmes and progress.

29. In February 2017, a Memorandum of Understanding was concluded between WHO and

UNODC setting out seven areas for collaboration. Coordination is thus being intensified in all

seven areas, at both the global and country levels. In line with decision WHA70(18), WHO organized

a side event at the Sixty-first session of the Commission on Narcotic Drugs.

30. In implementing the WHO/UNODC Joint Programme on Drug Dependence Treatment and

Care, the WHO Secretariat has been leading collaborative efforts in field testing the International

Standards for the Treatment of Drug Use Disorders. Results and recommendations for updating the

Standards were discussed at a joint UNODC/WHO meeting in February 2018. Also in collaboration

with UNODC, the Secretariat has developed a clinical tool and training materials to facilitate

implementation of the WHO guidelines for identification and management of substance use and

substance use disorders in pregnancy. A further joint undertaking to study the community-based

management of opioid overdose under the S.O.S. Initiative was launched at the Sixtieth session of the

Commission on Narcotic Drugs. Collaborative work with UNODC has also continued with the

development of information products on treatment and care for people with drug use disorders in

contact with criminal justice system (focusing on alternatives to conviction or punishment), on

identification and management of disorders due to use of new psychoactive substances, and on drug

epidemiology and statistics. UNODC and INCB also contributed significantly to discussions at the

WHO Forum on Alcohol, Drugs and Addictive Behaviours in June 2017.

31. The thirty-ninth meeting of the WHO Expert Committee on Drug Dependence met on

6–10 November 2017, with representatives of UNODC and INCB attending as observers. Both

UNODC and INCB support the Expert Committee’s prioritization process and provide information on

dependence, abuse potential and harm to health for the substances under review. The Committee

recommended that six fentanyl analogues, five synthetic cannabinoids and one amphetamine-type

stimulant be placed under international control. The fortieth meeting will take place in June 2018 and

will be specifically dedicated to reviewing cannabis and cannabis components.

32. The UNODC/WHO annual expert consultation on new psychoactive substances was held in

October 2017 in Vienna, with the objective of sharing information on the development of the WHO

surveillance system for new psychoactive substances and the UNODC Early Warning Advisory, and

to explore synergies between them. The WHO surveillance system will inform Member States about

the health risks of these substances, including fatal and non-fatal overdoses, related physical and

mental disorders, and impaired driving, thereby enabling timely action to be taken through the

establishment of vigilance or regulatory mechanisms.

33. WHO continues to work with UNODC to develop and implement normative guidance on

substance use and communicable diseases – in particular HIV, viral hepatitis and tuberculosis –

including on: amphetamine-type stimulant use and HIV transmission; differentiated HIV service

delivery for people who use drugs; continuity of HIV, tuberculosis and hepatitis care in prisons;

prevention of mother-to-child HIV transmission in prisons; and comprehensive prison services. WHO

and UNODC also contributed to the development of a document to facilitate the inclusion of specific

programmes for prisons in grant proposals submitted to the Global Fund to Fight AIDS, Tuberculosis

and Malaria.

34. Coordination and collaboration with UNODC and INCB will be strengthened to support

Member States’ implementation of the operational recommendations from the 2016 United Nations

General Assembly Special Session on Drugs. Successful collaboration, particularly at the country

A71/41

9

level, requires increased efforts to mobilize resources and strengthen WHO’s capacity to address the

world drug problem.

E. GLOBAL BURDEN OF EPILEPSY AND THE NEED FOR COORDINATED

ACTION AT THE COUNTRY LEVEL TO ADDRESS ITS HEALTH, SOCIAL

AND PUBLIC KNOWLEDGE IMPLICATIONS (resolution WHA68.20 (2015))

35. In May 2015, the Sixty-eighth World Health Assembly adopted resolution WHA68.20 on the

global burden of epilepsy and the need for coordinated action at the country level to address its health,

social and public knowledge implications. The present report provides the requested update on

progress made with regard to the implementation of the resolution.

36. Evidence-based guidelines and a comprehensive implementation package have been developed

and disseminated through an online sharing platform to strengthen countries’ capacities to develop and

scale up services for persons with epilepsy. The Secretariat has contributed to international advocacy

and raising awareness by developing a WHO information kit on epilepsy,1 which includes videos and

an infographic.

37. The WHO departments for Mental Health and Substance Abuse and for Neglected Tropical

Diseases have undertaken to develop guidelines on the diagnosis and treatment of Taenia solium

Neurocysticercosis to prevent epilepsy. These will be finalized in 2018.

38. In the African Region, where the treatment gap for epilepsy is particularly large, the Secretariat

facilitated a multicountry regional workshop in Ghana (September 2015) where policy-makers,

experts, people living with epilepsy, non-State actors and other key stakeholders from 17 Member

States were represented. In the Region of the Americas, a Regional epilepsy workshop was held in

Honduras (August 2015) to discuss successful experiences, progress, and lessons learned. In addition,

the mid-term review of the Strategy and Plan of Action on Epilepsy adopted in 2011 was presented at

the Twenty-ninth Pan American Sanitary Conference in September 2017.

39. The management of epilepsy has been integrated into primary health care as part of mental

health Gap Action Porgramme (mhGAP) implementation across all WHO regions. In the Western

Pacific Region, this strategy was initiated in rural China, and 14 other countries and areas

(Cook Islands, Fiji, Kiribati, the Federated States of Micronesia, Nauru, Niue, Palau, the Philippines,

Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu). In the Eastern Mediterranean

Region, epilepsy management in primary health care has been initiated in Egypt, Pakistan, and

Tunisia, and strengthened in Afghanistan, Jordan, Kuwait, Lebanon, Oman, Qatar and in the occupied

Palestinian territory. Similarly, epilepsy management is also integrated into mhGAP implementation

in countries in the European and South-East Asia regions.

40. The Secretariat has provided intensive and comprehensive technical support to four Member

States implementing innovative models of epilepsy care: Ghana, Mozambique, Myanmar and

Viet Nam. In the context of universal health coverage, epilepsy management is being integrated into

primary health care using a community-based approach. As a result, some 14 000 people living with

epilepsy have been identified and have gained access to quality care. Service coverage has increased

from 17% to 51% in the four countries’ implementing areas.

1 http://www.who.int/mental_health/neurology/epilepsy/information_kit_epilepsy/en/ (accessed 13 February 2018).

A71/41

10

41. Several initiatives have been undertaken to foster engagement with civil society and

international non-State actors to support the implementation of resolution WHA68.20. International

Epilepsy Day, a joint initiative by the International Bureau for Epilepsy and the International League

Against Epilepsy, promotes awareness of epilepsy. The day is marked in more than 120 countries each

year on the second Monday in February. In 2017, China marked the day by adopting the theme:

“Caring for school students with epilepsy”. A workshop was facilitated (September 2015) gathering

35 chapters of the International Bureau for Epilepsy, to promote the role of civil society in

implementing resolution WHA68.20. Furthermore, the Secretariat, in collaboration with the above

organizations, is preparing a global report on epilepsy to provide information and guidance on

approaches for improving policies, plans and programmes to increase access to epilepsy care in the

community.

F. COMPREHENSIVE MENTAL HEALTH ACTION PLAN 2013–2020

(resolution WHA66.8 (2013))

42. Through resolution WHA66.8 the Sixty-sixth World Health Assembly adopted the

comprehensive mental health action plan 2013–2020 in May 2013. This report summarizes progress in

implementing the action plan thus far.

43. The action plan includes six global targets and associated indicators to measure implementation.

Baseline data were collected from Member States in 2014, using the indicators agreed in the Mental

Health Atlas 2014 and again in 2017 to monitor progress. By January 2018, 177 Member States

submitted responses to the Mental Health Atlas questionnaire.

44. Since 2013, 104 Member States have updated their national mental health policy or plan in line

with international human rights instruments, and 94 have updated their legislation in line with

international human rights instruments. Availability of resources and services for mental health varies

considerably, remaining extremely limited in lower-income countries. The median number of mental

health workers globally, which has remained unchanged since 2013, is 9 per 100 000. Approximately

40% of Member States reported ongoing collaboration between mental health and social services.

Approximately 70% reported that care and treatment of persons with major mental disorders

(psychosis, bipolar disorder, depression) was included in their national health insurance or

reimbursement schemes, and more than 45% confirmed that these disorders were explicitly listed.

Preliminary analysis shows that 40% of Member States regularly prepare a specific report on mental

health activities. Less than 50% of countries have functioning prevention and promotion programmes.

Finally, regarding service coverage, response rates were much lower than for other aspects of the

questionnaire and quality of data was variable. This reflects current limitations in information systems

in countries.

45. Several initiatives have been undertaken to improve this situation. Regional mental health

strategies and frameworks for action have been developed: in September 2013, the Regional

Committee for Europe adopted the European Mental Health Action Plan 2013–2020;1 in

October 2014, the 66th session of the Regional Committee of WHO for the Americas adopted the Plan

of Action on Mental Health 2015–2020;2 in October 2014, the Regional Committee for the Western

Pacific approved the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in

1 See resolution EUR/RC63/R10.

2 See resolution CD53.R7.

A71/41

11

the Western Pacific;1 and in October 2015, the Regional Committee for the Eastern Mediterranean

adopted Scaling up mental health care: a framework for action.2 The Strategy for mental health for the

African Region is currently being reviewed.

46. WHO MiNDbank provides access to international resources and national policies, strategies,

laws and service standards related to mental health, substance abuse, disability and human rights from

192 countries.

47. Responding to lack of implementation of evidence-based psychological interventions, WHO

released two psychosocial guides that may be delivered by lay providers: a group psychological

treatment guide for depression, and a transdiagnostic scalable psychological intervention for adults

impaired by distress in communities exposed to adversity. WHO has also issued guidance on setting

up surveillance systems for suicide attempts and self-harm and has updated its guidance for media

professionals.

48. The Secretariat provides technical support across all regions on mental health, substance use

disorders, neurological conditions, suicide prevention and on system strengthening related to policy,

planning, law reform and service development, (including during and after conflict and natural

disasters). Significant focus has also been placed on human rights capacity building and promoting a

recovery approach in mental health. The intervention guide for WHO’s mental health Gap Action

Programme (mhGAP) and its implementation tools (mobile application and training package) has been

updated. It is available in 20 languages and currently being used in more than 100 countries. The

WHO QualityRights initiative is rapidly gaining momentum, with guidance and training tools being

implemented in more than 40 countries. The Secretariat led advocacy efforts for mental health,

including the very successful World Health Day in 2017 on depression, with the theme “Depression:

let’s talk”, and the organization of the annual mhGAP forum in Geneva, as well as participation in

global, regional and national events.

G. COMPREHENSIVE AND COORDINATED EFFORTS FOR THE

MANAGEMENT OF AUTISM SPECTRUM DISORDERS (resolution

WHA67.8 (2014))

49. In May 2014, the Sixty-seventh World Health Assembly adopted resolution WHA67.8 on

comprehensive and coordinated efforts for the management of autism spectrum disorders. The present

report provides the requested update on progress. The resolution requested the Director-General, inter

alia, to implement Health Assembly resolution WHA66.8 (2013) on the comprehensive mental health

action plan 2013–2020, as well as resolution WHA66.9 (2013) on disability, to scale up care for

individuals with autism spectrum disorders and other developmental disorders, as applicable, and as an

integrated component of the scale-up of care for all mental health needs.

50. In line with the resolution, the Secretariat is working towards the implementation of resolutions

WHA66.8 and WHA66.9 and the Global Strategy for Women’s, Children’s and Adolescents’ Health

(2016–2030) to ensure a coordinated approach to managing autism spectrum disorders and other

neurodevelopmental disabilities.

1 See resolution WPR/RC65.R3.

2 See resolution EM/RC62/R.5.

A71/41

12

51. The Secretariat has issued updated evidence-based guidance and capacity-building tools on

early detection and management of developmental delays and disorders, including autism spectrum

disorders, as a component of the mental health Gap Action Programme (mhGAP) Intervention Guide

version 2.0,1 along with a mobile application to provide advice and guidance to non-specialist care

providers at the primary health care level.2 These tools are being used in countries to strengthen

capacity for scaling up care.

52. The WHO caregiver skills training package has been made available for families of children

with developmental delays and disorders, through close cooperation with civil society partners like

Autism Speaks and others. This package promotes evidence-based management of autism and other

developmental disorders by providing skills training for caregivers. Workshops for health care

providers who work with children have been organized in Argentina (with participants from

six Member States in the WHO Region of Americas, August 2016), Nigeria (attended by child health

and mental health specialists from nine African countries May 2016), Bhutan (attended by 41 experts

from the South-East Asia Region) and in Xiamen (with participants from 14 low-, middle- and

high-income countries from different regions, December 2017). Technical support on policy

development and programming for autism and other neurodevelopmental disabilities has also been

provided to Member States.

53. The Secretariat has contributed to generating and disseminating evidence on scalable

approaches to managing autism and other developmental disorders, by providing technical advice and

support to more than 30 Member States across all regions, for adapting and field testing the

WHO mhGAP Intervention Guide and caregiver skills training, working closely with Member States,

other United Nations agencies, academic institutions and civil society organizations, including

parents’ associations.

54. In support of efforts to meet the Sustainable Development Goals and the objectives of the

Global Strategy for Women’s, Children’s and Adolescents’ Health (survive, thrive and transform),

WHO is working with UNICEF, supported by the Partnership for Maternal, Newborn and Child

Health, and the Action Network for Early Childhood Development, to develop a global framework for

nurturing care as a roadmap for action. This framework will outline how parents and other caregivers

can be supported to provide nurturing care for young children, including addressing the special needs

of caregivers and children with developmental difficulties and disabilities.

55. The Secretariat has contributed to international advocacy and raising awareness by participating

in and organizing events on United Nations World Autism Awareness Day and World Mental Health

Day, among others, in collaboration with advocate and self-advocate organizations.

1 http://www.who.int/mental_health/mhgap/mhGAP_intervention_guide_02/en/ (accessed 13 February 2018).

2 http://www.who.int/mental_health/mhgap/e_mhgap/en/ (accessed 13 February 2018).

A71/41

13

Promoting health through the life course

H. GLOBAL STRATEGY AND ACTION PLAN ON AGEING AND HEALTH

2016–2020: TOWARDS A WORLD IN WHICH EVERYONE CAN LIVE A

LONG AND HEALTHY LIFE (resolution WHA69.3 (2016))

56. The Sixty-ninth World Health Assembly in resolution WHA69.3 adopted the Global strategy

and action plan on ageing and health. It provides the political mandate to:

(a) achieve immediate country impact by building commitment, strengthening country

capacity and taking action where evidence is available; and

(b) establish the global evidence and partnerships needed to set up a decade of concerted

global action, the Decade of Healthy Ageing, from 2020 to 2030.

57. The following key activities have been undertaken by the Secretariat. Further information,

including additional quantifiable indicators, is provided on the WHO website.1

58. Building commitment and capacity. A total of 109 national focal points on ageing and health

have been identified and 85 countries currently have a national policy on ageing and health. Meetings

of Member States have been held to review regional strategies for the African and South-East Asia

regions and the Regional framework for action on ageing and health in the Western Pacific. To foster

understanding and commitment to long-term care in Sub-Saharan Africa, a regional policy dialogue

involving representatives of 28 countries was convened in partnership with the International

Association of Gerontology and Geriatrics. The WHO Global Network for Age-friendly Cities and

Communities has grown substantially to cover over 157 million people in more than

500 municipalities and other administrative levels across 37 countries.

59. Supporting country action. Guidelines for primary care practitioners on integrated care for

older people have been developed, together with an associated mobile health programme (mAgeing) to

provide easy access to recommendations and encourage their uptake. A global consultation has also

been held to identify the actions needed to support countries in the delivery of integrated care for older

people as part of universal health coverage. To support those who are closest to older adults, the

Secretariat has developed an online training programme designed to support caregivers of people

living with dementia. The Regional Office for Europe has issued guidance for policy-makers and

planners on the development of age-friendly environments. Members of the Global Network of

Age-friendly Cities and Communities have also contributed to setting up a database of specific

examples of how cities and communities are making their environments better places in which to grow

old.

60. Towards a Decade of Healthy Ageing. The Secretariat convened a global expert consultation

to guide the development of metrics to monitor healthy ageing and serve as a baseline for the Decade.

A public consultation has been conducted to identify priority areas for research, and the

Campbell-Cochrane Global Ageing review group will help identify and respond to evidence gaps in

the area of ageing. A global Clinical Consortium on Healthy Ageing has been established, bringing

together key geriatricians and researchers to provide guidance on clinical care, and South-East Asian

1 http://www.who.int/ageing/en/ (accessed 12 February 2018).

A71/41

14

Member States have initiated research into health systems’ response to population ageing. WHO has

also strengthened alignment and collaboration with other United Nations agencies and partners,

including the International Federation on Ageing and HelpAge International. A global campaign to

combat ageism is also underway, including activities to raise awareness through various high-level

events, establish a multi-stakeholder governance structure, and create an international research group

to ensure the campaign is evidence based. As requested through the resolution, the Secretariat is

working with key partners to develop a final proposal for the Decade of Healthy Ageing, to be

considered by the Seventy-second World Health Assembly.

61. Key challenges. Comprehensive action will require strengthened capacity at the country level.

The Secretariat is working with the Government of Malta to develop an online learning programme

that will be accessible globally.

Health systems

I. PROMOTING THE HEALTH OF REFUGEES AND MIGRANTS

(resolution WHA70.15 (2017))

62. In January 2017, the Executive Board at its 140th session requested several actions of the

Director-General in decision EB140(9). In May 2017, the Seventieth World Health Assembly adopted

resolution WHA70.15. This report describes the progress in implementing both.

63. Working with Member States and partners to ensure that health aspects of refugees and

migrants are adequately addressed in the development of the global compact on refugees and the

global compact for safe, orderly and regular migration. In response to the request in

decision EB140(9), the Secretariat provided input on health aspects for all issue briefs of the

six thematic sessions on facilitating safe, orderly and regular migration, held between April 2017 and

November 2017, including co-leading on health aspects in the issue brief for the first thematic

session.1 The Secretariat led an interagency group in the development of the “Proposed health

component in the global compact for safe, orderly and regular migration”, which was submitted for

input into the United Nations Secretary-General’s report “Making migration work for all”. The

Secretariat organized four side events during the thematic sessions and during the high-level meetings

of the 72nd session of the United Nations General Assembly in September 2017. Periodic

information-sharing sessions and bilateral meetings with Member States and partners were held in

Geneva and New York throughout 2017. The Secretariat worked closely with UNHCR and provided

input on health for the zero draft of the global compact on refugees, as well as providing technical

support to countries that host refugees.

64. Using the framework of priorities and guiding principles to promote the health of refugees

and migrants in order to increase advocacy at all levels. In response to the request in resolution

WHA70.15, the Secretariat presented the framework: at side events, jointly organized with Member

States and partners, at high-level meetings on migration in Geneva and New York; during the

Tenth Summit Meeting of the Global Forum on Migration and Development in Germany; and at other

global, regional and country meetings and workshops throughout 2017. Support was provided to

Member States and partners in adapting the framework to the regional context, resulting in regional

and subregional position papers in the Region of the Americas, South-East Asia Region and Eastern

1 On human rights of all migrants, social inclusion, cohesion and all forms of discrimination, including racism,

xenophobia and intolerance.

A71/41

15

Mediterranean Region. The Secretariat also worked with Member States and partners to ensure that the

issue of refugee and migrant health, and mention of resolution WHA70.15, was included in Human

Rights Council resolution 35/23 (2017),1 and that health was included in the Mayoral Declaration on

Migrants and Refugees: Meeting Needs, Protecting Rights and Fostering Empowerment,2 the first time

it has been included in a Mayoral Declaration.

65. Developing, reinforcing and maintaining the necessary capacities to provide health

leadership and providing support to Member States and partners in promoting the health of

refugees and migrants, in close collaboration with relevant stakeholders, and avoiding

duplication. In response to the request in resolution WHA70.15, the Secretariat has outlined

four strategic directions of its work to improve the health of refugees and migrants: providing support

to Member States in developing policies that promote refugees’ and migrants’ right to health and

ensure that their health needs are met by the national health system; ensuring that the delivery of

health services is culturally and linguistically appropriate; strengthening health monitoring and data

collection, to allow realistic priority-setting; and enhancing collaboration between countries and

sectors.

66. The topic of refugee and migrant health was included in the draft thirteenth general programme

of work, 2019–2023, its first inclusion in the Organization’s general programme of work. This should

help to ensure that the public health aspects of refugees and migrant are addressed in a coherent

manner across all levels of the Organization. In close collaboration with IOM and UNHCR, substantial

progress was made in 2017 in providing health leadership and technical and operational support to

Member States and partners. This included support for: public health interventions; implementation of

the strategy and action plan for refugee and migrant health in the WHO European Region3 and of

resolution CD55.R13 (2016) on the health of migrants;4 implementation of national plans on migration

in the South-East Asia Region; refugees and migrants in vulnerable situations in the context of

universal health coverage in countries of the Region of the Americas, South-East Asia Region and

Western Pacific Region; and development of a regional position paper and action plan on promoting

the health of refugees and migrants in the Eastern Mediterranean Region.

67. Identifying best practices, experiences and lessons learned on the health of refugees and

migrants in each region, in order to contribute to the development of a draft global action plan. In response to the request in resolution WHA70.15, the Secretariat issued a global call for information,

including case studies, on current policies and practices, and lessons learned in promoting refugee and

migrant health. Between August 2017 and January 2018, 199 submissions were received, covering

85 countries, from 52 Member States and partners. Each region conducted a situation analysis: their

reports, including best practices and a collection of practices, will be published on the WHO website.

The draft global action plan will be developed and issued for consultation in the second half of 2018.

1 On the right of everyone to the enjoyment of the highest attainable standard of physical and mental health in the

implementation of the 2030 Agenda for Sustainable Development.

2 Endorsed at the 4th Mayoral Forum on Human Mobility, Migration and Development, held in Germany in 2017.

3 See resolution EUR/RC66/R6 (2016).

4 Adopted by the 55th Directing Council of PAHO at the 68th session of the Regional Committee for the Americas.

A71/41

16

J. STRENGTHENING INTEGRATED, PEOPLE-CENTRED HEALTH SERVICES

(resolution WHA69.24 (2016))

68. In May 2016 the Sixty-ninth World Health Assembly, in resolution WHA69.24, adopted the

framework on integrated, people-centred health services and requested the Director-General: to

provide technical support and guidance to Member States for the implementation, national adaptation

and operationalization of the framework; to ensure that all relevant parts of the Organization, at all

three levels, are aligned, actively engaged and coordinated in promoting and implementing the

framework; and to perform research and development on indicators to trace global progress on

integrated people-centred health services. This report provides details of the activities undertaken by

the Secretariat in response to this resolution.

69. Capacity-building and provision of support to Member States. The framework on

integrated, people-centred health services has been adapted to national health policies and strategic

plans in 12 countries. Additionally, in the African Region improvements to hospital management and

the organization of health records have been made in three countries. In South Africa, for instance,

implementation of people-centred care principles in one district has yielded a 19% increase in the

proportion of patients receiving care in less than two hours following presentation at a health care

facility. The Regional Office for the Americas has supported health reforms in five countries in the

Region, as well as the integration of health services in 10 countries. National training of trainers

courses for building capacities of general practitioners and hospital managers have been implemented

in 10 countries in the Eastern Mediterranean Region. In the Western Pacific Region, six country

offices have collaborated with Member States on a range of service delivery reforms. A further

three countries of the Region have developed strategies to integrate traditional medicine into their

national health system.

70. Development of technical documents, instruments and tools. The Secretariat, in

collaboration with experts and international organizations, has developed position papers on the role of

hospitals within the framework, and on high-performing primary health care (linked to the

40th anniversary of the Alma-Ata Declaration). Policy and practice briefs have been drafted to provide

evidence-informed recommendations on implementing the framework in a variety of contexts. The

topics of these briefs include: reaching the underserved and marginalized populations; integrating

vertical programmes into health systems; health innovation; and continuity and coordination of care.

Additionally, the Secretariat has prepared a document entitled Critical pathways towards integrated

people-centred health services that will be accompanied by an assessment and planning toolkit to

support subnational health authorities in health planning.

71. Knowledge exchange. A web-based knowledge platform, “IntegratedCare4People”, has been

launched by WHO to support the exchange of knowledge on the framework across regions, countries

and stakeholder groups. As at May 2018, 70 case studies and 400 resource documents have been

added to the platform. In addition, three communities of practice have been established. In 2017 the

platform attracted over 4000 new visitors.

72. Building the evidence base and monitoring progress. A total of 14 indicators for monitoring

global progress on integrated, people-centred health services, as well as 19 indicators for measuring

national and subnational improvement, have been identified through an expert review, using the

Delphi technique. Where possible, these indicators have been drawn from global reference lists,

including the WHO global reference list of 100 core health indicators (plus health-related Sustainable

Development Goals). Additional indicators that require further research and development have also

been identified.

A71/41

17

73. Partnership development. The Secretariat continues to work closely with all existing partners,

including WHO collaborating centres (on integrated health services and primary health care),

international organizations such as the International Foundation for Integrated Care, development

agencies and academic institutions, while also seeking opportunities to engage with new actors. The

launch of the WHO Global Service Delivery Network has been crucial in raising the profile of the

framework to ensure that it remains visible, and a high priority on the international health agenda.

74. Mainstreaming. The capability of staff members of the Organization to bring the framework

into the mainstream of their work has also been strengthened through technical meetings, and through

the provision of advice and support to those working in other technical programme areas, including

ageing and life course, and gender, equity and human rights.

The way forward

75. Despite significant progress made by the Secretariat in response to resolution WHA69.24, a

considerable amount of work remains to be done. The 40th anniversary of the Alma-Ata Declaration

this year will be an important milestone to reaffirm the role of integrated, people-centred health

services and primary health care as the foundation of WHO’s efforts to achieve universal health

coverage. The Secretariat will continue to provide technical support and guidance to Member States in

their efforts to adapt the framework to their national strategies and plans, and will provide support to

them in monitoring and evaluating health service delivery reforms.

K. PROMOTING INNOVATION AND ACCESS TO QUALITY, SAFE,

EFFICACIOUS AND AFFORDABLE MEDICINES FOR CHILDREN

(resolution WHA69.20 (2016))

76. In response to resolution WHA69.20 (2016), Member States, in collaboration with the

Secretariat and partners, are working to promote innovation and access to quality, safe, efficacious and

affordable medicines for children through the following: formulation and implementation of policies

and plans that aim to improve children’s health and improve access to children’s medicines;

establishment of processes for the evidence-based selection of children’s medicines for the national

essential medicines list and for reimbursement and procurement decisions; collection and analysis of

data on pricing and use of children’s medicines; and strengthening of the national regulatory system to

promote quality, ethical clinical trials of medicines for children.

77. The following key activities have been undertaken by the Secretariat in line with the resolution.

78. The Secretariat, in collaboration with partners, convened the third meeting on Paediatric

Antiretroviral Drug Optimization in December 2016, to take stock of progress made and to further the

discussion on optimal treatment.1 The meeting facilitated coordination across the continuum of

antiretroviral drug development. Lessons learned in prioritization of antiretroviral drug development

that could apply to medicines for other diseases, such as viral hepatitis and tuberculosis, were

discussed with the goal of identifying synergies and promoting alignment in drug and formulation

development of anti-infective agents for children.

1 See Paediatric Antiretroviral Drug Optimization (PADO) Meeting 3. Geneva: World Health Organization

(http://www.who.int/hiv/pub/meetingreports/paediatric-arv-optimization-pado3/en/, accessed 13 February 2018).

A71/41

18

79. Work is under way to re-establish the Paediatric medicines Regulators Network and a meeting

will be held in June 2018 with regulators and other stakeholders to define the terms of reference for

the network. It is envisaged that the network will provide a forum for discussion, facilitate

collaboration and build capacity on regulatory issues concerning paediatric medicines. An online

platform has been established by the Secretariat for sharing regulatory guidelines, standard treatment

guidelines and other important information relevant to paediatric medicines.

80. Since 2016, 14 child-friendly products for the treatment of HIV infection, tuberculosis, malaria

and diarrhoeal diseases have been prequalified by WHO, providing vital information on quality

assurance of these products for agencies and organizations involved in bulk purchasing of medicines.

81. In 2017, six paediatric specialists were included in the WHO Expert Committee on the Selection

and Use of Essential Medicines. The Expert Committee analysed systematic reviews on diarrhoeal

diseases, cholera, community-acquired pneumonia, sepsis and severe malnutrition, as a common

approach to gathering evidence for updates to the 6th WHO Model List of Essential Medicines for

Children and WHO standard treatment guidelines for paediatric indications of these conditions.

Reviews of optimal dosing for paediatric antibiotic treatments are under way, for discussion at the next

meeting of the Expert Committee in 2019.

82. Technical assistance has been provided to six countries1 through the Maternal, Newborn and

Child Health Muskoka Initiative for improving access to safe, effective and quality medicines. Support

was provided for strengthening procurement and supply chain management, developing policies for

generic medicines, monitoring access, revision of national essential medicines lists and standard

treatment guidelines, assessment of the pharmaceutical workforce and strengthening communities of

practice.

83. Technical support was provided to China through the China–WHO Biennial Collaborative

Project 2016–2017 on Drug Safety and Accessibility in Children. The project covers the development

of strategies for promoting: the development of a national essential medicines list for children; the

regulation of off-label use of medicines for children; the production of priority essential medicines for

children; and improved pricing and supply mechanisms.

84. The project Speeding Treatments to End Paediatric Tuberculosis, implemented by the Global

Alliance for TB Drug Development and the Secretariat, facilitated early availability of new paediatric

formulations at an affordable price, through the Stop TB Partnership Global Drug Facility. Extensive

planning and engagement with target countries facilitated rapid uptake of these new fixed-dose

combinations.

L. SUSTAINABLE HEALTH FINANCING STRUCTURES AND UNIVERSAL

COVERAGE (resolution WHA64.9 (2011))

85. A growing number of countries have made more explicit political commitment to universal

health coverage in their national policies. Since the 2015 update,2 WHO has supported over

100 countries from all regions with technical assistance, policy dialogue and capacity building related

to health financing. This has included facilitation of cross-country exchange of experience, synthesis

1 Benin, Côte d’Ivoire, Guinea, Mali, Niger and Senegal.

2 See document A68/36, section L.

A71/41

19

of key lessons learned, health financing training programmes, diagnostic analysis of the main technical

challenges and priorities for country reforms, and high-level dialogue to address key political factors

in implementation.

86. The evidence shows that problems emerge when both out-of-pocket payments and voluntary

health insurance account for a large share of total health spending; conversely, greater public spending

on health enhances financial protection. In support of universal health coverage, countries at all levels

of income have taken steps to sustain public funding. One approach is to increase the priority given to

health in public resource allocation, as in the Islamic Republic of Iran. Another has been to change the

flow and purpose of general budget revenues, for example in India, where national and many state

budgets fund health insurance coverage for the poor. Many countries have also diversified sources of

public funding, for example, by combining general tax revenues with the direct contribution of the

insured population in countries that make use of social health insurance. This has proved to be a useful

strategy in both lower- and higher income countries. In Estonia, the Government recently decided to

increase tax transfers to the Estonian Health Insurance Fund and thereby diversify its funding base

beyond almost sole reliance on employer−employee contributions.

87. Further support for universal health coverage has come through the recognition that reducing

fragmentation in the pooling of prepaid funds creates the best opportunity for directing resources

towards the greatest need. Merging general revenues with social insurance contributions in a common

pool is an approach that many countries use. This also enhances efficiency by consolidating the

management of these funds. The consequences of fragmentation can also be mitigated by unifying

benefit entitlements and provider payment methods. Implementation is made possible through a

unified national information platform serving multiple schemes or regions.

88. Progress cannot be made towards universal health coverage unless funds are used well. The

main health financing instrument to ensure appropriate use is “strategic purchasing” of health services,

which involves linking the payments of providers to data on their performance and the health needs of

the population they serve. As recognition of the power of this instrument has grown since the

Secretariat’s previous report, so too have efforts to strengthen and analyse such mechanisms.

Experience suggests that more strategic purchasing in health systems calls for a focus on three broad

areas: (1) mechanisms for selecting and modifying the services to be purchased, including health

technology and budget impact assessments; (2) provider payment methods to incentivize efficiency

and equity gains, and support effective delivery of promised services; and (3) strengthened capacities,

management systems, and governance of the agency or unit responsible for implementing strategic

purchasing, including the analysis of data generated by the payment system and its application in

future policy and payment decisions.

89. The momentum given to universal health coverage by the 2030 Agenda for Sustainable

Development has reinforced the need for high-quality progress monitoring. A universal health

coverage monitoring report was issued in late 2017.1

90. The system for classifying health expenditures has been revised in collaboration with OECD

and Eurostat. As a result, more disaggregated and policy-relevant health expenditure tracking can be

performed using the online WHO Global Health Expenditure Database. This allows for continued

1 Tracking universal health coverage: 2017 global monitoring report. World Health Organization and International

Bank for Reconstruction and Development/The World Bank: 2017

(www.who.int/healthinfo/universal_health_coverage/report/2017/en/, accessed 6 February 2018).

A71/41

20

monitoring of high-priority concerns and also provides new insights that are critical to sustainable

financing, such as the extent to which domestic health spending is funded from external aid.

91. Many challenges remain, and, in future, it will be essential to build on what has worked while

increasing the focus on issues that merit more attention.

92. Experience has shown that for reforms to go beyond small pilot initiatives, close engagement

with national finance and budgetary authorities is essential.

93. For sustainable progress towards universal health coverage to be maintained, a truly

comprehensive approach is needed. Effective design and implementation requires coherence with

other changes, such as those in service delivery and governance. All too often, insufficient attention is

paid to population-based services and public health programmes.

94. There is a continuing need to improve data quality and analysis. Countries should seize the

opportunity to make more effective use of strategic purchasing databases in order to create a virtuous

cycle of data quality, use and analysis.

95. Renewed political commitment remains essential if countries around the world are to make

equitable progress towards universal health coverage.

M. AVAILABILITY, SAFETY AND QUALITY OF BLOOD PRODUCTS (resolution

WHA63.12 (2010))

96. Strengthening national blood supply systems. The WHO Secretariat has provided country

support for national blood policies and supply systems in 12 countries1 and has supported the

strengthening of national blood transfusion services in countries affected by Ebola virus disease.

During the recent outbreak of Zika virus disease, WHO provided emergency guidance.

97. In the Eastern Mediterranean Region, the regional strategic framework for blood safety and

availability (2016–2025) was endorsed by the Sixty-third session of the Regional Committee for the

Eastern Mediterranean.2 Assessments and a regional consultation have been conducted to strengthen

emergency preparedness and response capacity in 11 countries and territories in respect of blood

transfusion.3 The Regional Office for South-East Asia organized a regional workshop for national

blood programme managers to review the existing capacities of blood transfusion services in order to

identify challenges and develop action plans.

98. World Blood Donor Day is celebrated in a growing number of countries and to provide a focus

for campaigns on voluntary non-remunerated blood donation. The Secretariat has supported many

Member States in conducting national World Blood Donor Day campaigns, and in developing or

improving blood donor management.

1 Bangladesh, Bhutan, Cambodia, Congo, Côte d’Ivoire, Ethiopia, Gabon, Maldives, Myanmar, Nepal, Pakistan and

South Sudan.

2 See resolution EM/RC63/R.5.

3 Afghanistan, Iran (Islamic Republic of), Jordan, Lebanon, Libya, Pakistan, Somalia, Sudan, Syrian Arab Republic,

Yemen and in the occupied Palestinian territory.

A71/41

21

99. Quality systems and haemovigilance. In 2016, WHO published guidance on establishing

national haemovigilance systems and on implementing external quality assessment programmes for

screening donated blood for transfusion-transmissible infections. In December 2016, the

WHO Regional Office for the Eastern Mediterranean organized a regional consultation on

haemovigilance with the aim of launching the WHO guidance documents in the Region. The

Secretariat has supported Algeria, Bhutan and Pakistan in developing and implementing

haemovigilance systems. Information on blood safety and availability was collected, analysed and

disseminated through WHO’s global database on blood safety. A report was published based on the

data reported to the Secretariat by Member States.

100. National blood regulatory systems. The Organization has provided support for the assessment

of regulatory systems in three countries, and for building the capacity of authorities and transfusion

services in 18 countries in the African Region.1 WHO has reviewed existing blood legislations in the

countries in WHO Region for the Eastern Mediterranean and developed a template legislation that can

be adapted by countries to foster adherence to good manufacturing principles and harmonization

across countries in the Region.

101. Expert Committee on Biological Standardization. The Committee established the guidelines

on management of blood and blood components as essential medicines and on the estimation of

residual risk in blood components for transmissible viruses, and international reference preparations

for blood products and in vitro diagnostics, including those needed for detection of pathogens in

disease outbreaks. The WHO guidelines for the production, control and regulation of snake antivenom

immunoglobulins were revised.

102. Safe and rational use of blood and blood products. The Secretariat has provided technical

support to countries in developing systems and capacities for the appropriate use of blood. WHO has

begun updating the WHO handbook on the clinical use of blood in collaboration with the International

Society of Blood Transfusion.

103. Challenges and next steps. Progress has been made, but major challenges remain for many

low- and middle-income countries in providing a sufficient and safe supply of blood and blood

products. In future, the Secretariat will continue to support countries to build effective and sustainable

blood supply systems and achieve the vision of universal access to safe blood and blood products for

all countries.

N. HUMAN ORGAN AND TISSUE TRANSPLANTATION (resolution WHA63.22

(2010))

104. In resolution WHA63.22 (2010), the World Health Assembly endorsed the WHO Guiding

Principles on Human Cell, Tissue and Organ Transplantation, which have since influenced the

creation and modification of laws, legislation and regulations in some 60 countries, and have served as

a model for improving or building donation and transplantation programmes globally. The Guiding

Principles are helping Member States to combat commercial transplantation more effectively and

simplify donation after brain- and cardio-circulatory death, as well increasing protection for living

donors.

1 Benin, Burkina Faso, Burundi, Cameroon, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia,

Ghana, Guinea, Kenya, Mauritius, United Republic of Tanzania, Togo, Senegal, South Africa, Zambia and Zimbabwe.

A71/41

22

105. During the 136th session of the Executive Board in January 2015, the Secretariat was requested

to convene consultations with Member States and international partners to develop global consensus

on guiding ethical principles for the donation and management of all medical products of human

origin beyond the scope of human cell, tissue and organ transplantation. Several other types of these

products have human clinical applications and significant commonalities inherent to their human

origin. The safety issues for donors and recipients are therefore very similar, including the need to

ensure quality, traceability, vigilance, surveillance and equitable access to these products in the

context of universal health coverage.

106. The Secretariat has responded to the growing interest in all issues related to medical products of

human origin, developing a special initiative in the Health Systems and Innovation Cluster to foster

consistency of ethical practices in order to strengthen the overall safety, quality and availability of

such products.

107. Since different types of medical products of human origin can require different operational

systems and regulatory oversight adapted to their specificities, 10 new guiding principles, aligned with

resolution WHA63.22, were proposed at the Seventieth World Health Assembly. The Secretariat is

working on the creation of a task force that will assist Member States in developing their donation

programmes in line with those guiding principles. The task force’s main objectives are to analyse

barriers to implementation of the Guiding Principles at the global and national levels, identify

high-risk areas and guide intervention, provide evidence-based support and capacity-building at the

regional and country levels, at WHO’s request, and establish a global governance mechanism for

efficient coordination of efforts to combat organ trafficking and transplant tourism, including to

improve transplantation registries.

108. Data on activities and practices are collected by the Global Observatory on Donation and

Transplantation,1 a collaborative project between WHO and the Spanish National Transplant

Organization. The practice of organ transplantation is increasing worldwide, and is currently carried

out in over 110 countries, a global increase of more than 12% over the past four years, with a

significant increase around 50% in Latin American countries. Despite this growth, these figures still

fall far short of meeting actual needs.

109. The Notify Library,2 developed jointly by WHO and the Italian National Transplant Centre, has

updated the Notify Booklet, which targets clinicians and health authorities, to provide a better didactic

overview of vigilance and surveillance related to medical products of human origin.

110. In April 2017, the Argentinian National Coordination Centre for Donation and Transplantation

was designated as a WHO collaborating centre. The Centre will assist the Pan American Health

Organization in reinforcing policies, enhancing training, and developing donation and transplantation

programmes in the Region of the Americas.

111. The Secretariat has also increased collaboration with other United Nations entities on

implementing United Nations General Assembly resolution 71/322 (2017), to prevent and combat

trafficking in persons for the purpose of organ removal and trafficking in human organs, which is in

line with WHO Guiding Principles 5, 6 and 7.

1 http://www.transplant-observatory.org/ (accessed 12 February 2018).

2 http://www.notifylibrary.org/ (accessed 14 February 2018).

A71/41

23

O. WHO STRATEGY ON RESEARCH FOR HEALTH (resolution WHA63.21 (2010))

112. In January 2016, a demonstration version of the Global Observatory on Health R&D was

published online. User feedback was taken into consideration and the Observatory was launched on

19 January 2017.1 Its data sources, which cover a range of data and analysis relevant to health research

and development, include: funding flows for product-related health research and development for

neglected diseases; health products that are under development; research publications; clinical trials;

health researchers capacity; and other relevant global indicators for comparisons, such as gross

domestic expenditure on health research and development, and official development assistance by

donor and recipient country for medical research and basic health sectors. The Observatory has

continued to grow since its launch, totalling 19 data sources by the end of 2017.

113. Responding to resolution WHA67.25 (2014) on tracking research and development resources

for antimicrobial resistance, and the Secretariat report on options for strengthening

information-sharing on diagnostic, preventive and therapeutic products, submitted to the Executive

Board at its 138th session in document EB138/28, the secretariat of the Global Observatory on

Health R&D is working closely with the WHO secretariats for antimicrobial resistance and for the

research and development blueprint for action to prevent epidemics to track and analyse research and

development relevant to antimicrobial resistance and epidemics through data in the Observatory.

114. In relation to the “Organization Goal” of the WHO strategy on research for health, WHO’s

Guidelines Review Committee and its secretariat provide WHO with stringent quality assurance

processes for its guidelines, as well as its support and quality improvement activities, and for the

development of new methods and approaches. During the biennium 2016−2017, the Committee

approved 49 sets of technical normative guidelines for Member States. In addition, the secretariat

provided over 500 consultations and organized 26 seminars and workshops for Secretariat staff at

headquarters and in the regional offices in order to facilitate the development of trustworthy and

impactful guidelines.

115. The Secretariat has expanded its collaboration and partnerships with various key stakeholders in

health research and development to ensure effective communication of WHO’s positions and

priorities, and a more harmonized approach to data sharing. Examples of partnerships and

collaboration include: the G7 Health R&D working group and G20 discussions; Heads of International

Research Organizations through its membership of the Steering Group of the World RePORT

platform, which collates, on an annual basis, data on health research grants from key funders; and the

Coalition for Epidemic Preparedness and Innovations, which funds new vaccine research and

development targeting emerging infectious diseases prioritized by the WHO research and development

blueprint.

116. On 18 May 2017, in response to the Secretariat’s concerted efforts to increase public disclosure

of the results of clinical trials, some of the world’s largest funders of medical research and

international non-State actors agreed new standards, according to which all clinical trials that they

fund or support must be registered and the results disclosed publicly.2 Currently, 30–50% of clinical

trials go unreported, sometimes because the results are negative or inconclusive. These unreported

results leave an incomplete and potentially misleading picture of the risks and benefits of vaccines,

1 See Global Observatory on Health R&D (http://www.who.int/research-observatory/en/, accessed 9 March 2018).

2 See International Clinical Trials Registry Platform (ICTRP) (http://www.who.int/ictrp/results/jointstatement/en/,

accessed 9 March 2018).

A71/41

24

drugs and medical devices, and can lead to the use of suboptimal or even harmful products. By the end

of 2017, 21 key funders had signed a joint statement affirming their commitment to the new standards.

117. Secretariat activities in the field of global health ethics have contributed to three goals of the

strategy.

• Organization goal. The relevant Secretariat staff supported: (i) the development of both the

code of conduct for responsible research, and policy on misconduct in research; (ii) improved

staff competencies in research ethics by developing e-training courses on ethics for

conducting research during disaster; (iii) strengthened ethical standards through ongoing work

of the WHO Ethics Review Committee.

• Capacity goal. Training tools and guidance were developed in relation to ethics of

operational research.

• Standards goal. Three major sets of WHO guidelines were developed: WHO guidelines on

ethical issues in public health surveillance; Guidance for managing ethical issues in

infectious disease outbreaks; and Ethics in epidemics, emergencies and disasters: research,

surveillance and patient Care: training manual.1

118. Regional offices have continued to be active in implementing the WHO strategy on research for

health, and advisory committees on health research have remained active in five of the six regional

offices. The Evidence Informed Policy Network is active at the country and regional levels in the

African, European and Eastern Mediterranean regions, and in the Region of the Americas.

P. WORKERS’ HEALTH: GLOBAL PLAN OF ACTION (resolution WHA60.26

(2007))

119. In 2013, the Sixty-sixth World Health Assembly noted the progress made during the period

2008–2012 on the implementation of the global plan of action on workers’ health 2008–2017.2

120. This report describes the progress made by the Secretariat on the five objectives of the global

plan of action on workers’ health 2008–2017 since 2013.

Objective 1: to devise and implement policy instruments on workers’ health

121. Technical support was provided to 13 countries in developing national profiles and action plans

for workers’ health and for strengthening relevant capacities of health ministries.

1 WHO guidelines on ethical issues in public health surveillance. Geneva: World Health Organization; 2017;

Guidance for managing ethical issues in infectious disease outbreaks. Geneva: World Health Organization; 2016 and Ethics

in epidemics, emergencies and disasters: research, surveillance and patient care: training manual. Geneva: World Health

Organization; 2015.

2 See documents A66/27, section J, and WHA66/2013/REC/3, summary records of Committee B, seventh meeting,

section 1.

A71/41

25

122. A global framework for national programmes for occupational health and safety of health

workers was elaborated jointly with ILO, and support was provided to 12 countries for developing

such programmes. This work also contributes to the ILO, OECD and WHO action plan for health

employment and inclusive economic growth (2017–2021).

Objective 2: to protect and promote health at the workplace

123. The Secretariat developed guidelines for protecting workers from potential risks of

manufactured nanomaterials and compiled minimum requirements for workplace health protection.

Practical tools and capacity-building materials for work improvement in health care facilities were

published jointly with ILO, and implementation support was provided to eight countries.

124. Recommendations were issued on working with the private sector to stimulate healthy

behaviours among workers and for the prevention and control of noncommunicable diseases at the

workplace. An information sheet on mental health in the workplace was published on the 2017 World

Mental Health Day. Occupational risks for tuberculosis, particularly among miners and health care

workers, were tackled in the WHO Global Ministerial Conference Ending TB in the Sustainable

Development Era: A Multisectoral Response (Moscow, 16–17 November 2017).

125. Recommendations on the protection of occupational safety and health were issued and updated

jointly with ILO in 2014 during the outbreak of Ebola virus disease in West Africa, and interim

guidance was developed on occupational safety and health in emergency vector control of Aedes

mosquitoes. A WHO/ILO manual on occupational safety and health in outbreaks and public health

emergencies was published, covering different types of risks and emergencies. The Secretariat

organized training for national focal points for occupational health and emergency preparedness from

17 African countries (held in Johannesburg, South Africa, in 2016) and capacity-building for work

improvement in health care facilities in eight countries (in 2016 and 2017).

Objective 3: to improve the performance of and access to occupational health services

126. Regional consultations and conferences on scaling up workers’ health coverage with essential

interventions and basic occupational health services were held in Semnan, Islamic Republic of Iran

(2014), Bangkok, Thailand (2016) and Saint Petersburg, Russian Federation (2017) to develop

indicators and road maps, disseminate good practices and promote intercountry collaboration.

127. A set of essential interventions for workers’ health was included in the United Nations

OneHealth costing tool to allow countries to plan and cost their delivery at the primary care level and

to develop scenarios for scale-up. A toolkit for building capacities of primary care providers to deliver

these essential interventions is being elaborated.

128. Migrant workers’ access to occupational health services was further promoted under the

framework of priorities and guiding principles to promote the health of refugees and migrants.

129. The Secretariat also assessed the effectiveness of different schemes for financial health coverage

of workers in the informal economy.

A71/41

26

Objective 4: to provide and communicate evidence for action and practice

130. The Secretariat worked with ILO to develop diagnostic and exposure criteria for occupational

diseases. WHO and ILO also started developing a joint methodology for estimating work-related

burden of disease.

131. A global workers’ health database of existing international indicators measuring workers’ health

status and its determinants was compiled with data by country, and a visualization tool is being

developed to allow countries to monitor workers’ health and develop national profiles.

Objective 5: to incorporate workers’ health into other policies

132. The Secretariat published an overview of occupational health aspects related to green

technologies and climate change. It contributed to the implementation of the United Nations toolkit for

mainstreaming employment and decent work and to the Minamata Convention on Mercury.

Implementation

133. Specific initiatives to implement the global plan of action at the regional level included: Plan of

Action on Workers’ Health 2015–2025 in the Region of the Americas, Regional Framework for

Action on Occupational Health 2011–2015 in the Western Pacific Region, and the South East

European Network on Workers’ Health. Priority actions on workers’ health were also included in the

Regional Strategy for the Management of Environmental Determinants of Human Health in the

African Region 2017–2021, the Arab Strategy on Health and Environment 2017–2030, and the

outcomes of the fifth and sixth ministerial conferences of the European Environment and Health

Process (held in Parma, Italy, 10–12 March 2010 and Ostrava, Czechia, 13–15 June 2017,

respectively).

134. The global network of 45 WHO collaborating centres for occupational health supported the

Secretariat in the prevention of occupational noncommunicable diseases, safety of health care workers,

capacity-building for early detection of occupational diseases, assessing workers’ health metrics, and

workers’ health in the informal economy.

135. The Secretariat organized events to promote workers’ health at three global congresses

organized by ILO and the International Commission on Occupational Health.

136. Continuous financial support for the Secretariat’s normative work on the implementation of the

global plan of action on workers’ health was received from the governments of the United States of

America and the United Kingdom of Great Britain and Northern Ireland.

A71/41

27

Health emergencies programme

Q. SMALLPOX ERADICATION: DESTRUCTION OF VARIOLA VIRUS STOCKS

(resolution WHA60.1 (2007))

137. At the Sixty-ninth World Health Assembly in May 2016, Member States discussed the issue of

the timing of the destruction of existing variola virus stocks. Given the advent of synthetic biology

technologies, which makes it possible to create variola virus using publicly available information and

common laboratory procedures, the Health Assembly urged the WHO Advisory Committee on Variola

Virus Research to review the current research needs using live variola virus. It agreed to include on the

provisional agenda of the Seventy-second World Health Assembly in 2019 a substantive item on the

destruction of variola virus stocks in order to allow time for any additional research, with annual

progress reports submitted to the Health Assembly in the interim on the status of the research.1

138. This progress report provides an overview of the work undertaken by the Secretariat since the

Seventieth World Health Assembly in May 2017. It summarizes the proceedings and conclusions of

the nineteenth meeting of the WHO Advisory Committee on Variola Virus Research (Geneva, 1 and

2 November 2017) and provides an update on the status of the biennial biosafety inspections of the

two authorized repositories of variola virus stocks (the WHO Collaborating Centre for Orthopoxvirus

Diagnosis and Repository for Variola Virus Strains and DNA, State Research Centre for Virology and

Biotechnology (VECTOR), Koltsovo, Novosibirsk Region, Russian Federation, and the

WHO Collaborating Centre for Smallpox and Other Poxvirus Infections, Centers for Disease Control

and Prevention (CDC), Atlanta, Georgia, United States of America).

139. At its nineteenth meeting, the Advisory Committee received reports from the Secretariat on its

work during the previous year and from the two collaborating centres on the virus collections in the

repositories. The Advisory Committee reviewed the work of each collaborating centre on the

authorized programme of research with live variola virus. In 2017, six ongoing research proposals

were received by WHO and evaluated by the Advisory Committee’s Scientific Subcommittee; five (all

from CDC) were deemed to be “essential research for public health benefit that requires use of live

variola virus” and therefore were recommended by the Scientific Subcommittee for approval by

WHO. The Advisory Committee also received updates on the regulatory and licensure status of

diagnostic tests, antivirals and smallpox vaccines.

140. The Advisory Committee carefully considered the progress made in ongoing research and future

research needs requiring live variola virus. It noted the advances in the area of diagnostics (a licensed

real-time polymerase chain reaction (PCR) assay and a protein-based one in development) and the

forthcoming submissions of licensure applications to the United States Food and Drug Administration

for: one antiviral (imminent) and for another (in the pipeline), as well as for a third-generation vaccine

(later in 2018). The Advisory Committee was informed of and acknowledged the benefits of variola

virus research, especially for the control of other orthopoxviruses, particularly monkeypox, which is

currently endemic in Central and West Africa. Overall, the Advisory Committee emphasized the need

for preparedness at the country and global levels, in particular the availability and accessibility of

diagnostics and other related tools.

1 See document WHA69/2016/REC/3, summary records of Committee A, sixth meeting.

A71/41

28

141. The current round of the WHO’s biennial biosafety inspections of the repository sites was

completed at VECTOR (10–15 October 2016) and at CDC (8–12 May 2017), with the same

international team of biosafety experts for both inspections, led by WHO. The protocol used for the

inspections follows the European Committee for Standardization’s Laboratory Biorisk Management

Standard CWA 15793, which covers 16 elements of laboratory biorisk management. Reports of both

inspections are in the final stages of approval and will be made available on the WHO website. The

next round of inspections is being planned and will take place in 2018 and 2019.

Corporate services/enabling functions

R. MULTILINGUALISM: IMPLEMENTATION OF ACTION PLAN (resolution

WHA61.12 (2008))

142. The multilingualism: plan of action was adopted by the Sixty-first World Health Assembly in

May 2008.1 The present report summarizes progress in implementing the action plan requested in

resolution WHA61.12.

143. Efforts to increase multilingual content on the WHO website have continued. The multilingual

team of web editors, working with the Secretariat’s translation service, has reduced the gap in

availability of technical content between English and the other five official languages of the

Organization. The team has also made all corporate web content available in the six official languages.

During the biennium 2016–2017, 1371 webpages were added in Arabic, 1918 in Chinese, 9739 in

English, 2181 in French, 1747 in Russian and 1828 in Spanish. Some 150 million readers visited

WHO multilingual website during that period.

144. As at February 2018, WHO’s Institutional Repository for Information Sharing (IRIS) included

more than 205 000 records in the official languages, comprising WHO information products and

governing bodies documentation (including Health Assembly and Executive Board documentation

from 1948 onwards). The Repository is currently tracking an average of 2.9 million downloads per

month.

145. In 2017, the Russian Federation provided funds to support a second project for increasing the

quality and quantity of WHO’s technical and scientific information products available in the Russian

language, and for improving their dissemination to Russian-speaking audiences: 19 publications will

be translated and published in Russian at headquarters and in the Regional Office for Europe, and

20 existing print publications in Russian will be digitized and stored in IRIS. Two special issues of the

Bulletin of the World Health Organization in Russian and four issues of the journal Public Health

Panorama will be published. A data and evidence section in Russian will be created on the website of

the Regional Office for Europe. A Russian language glossary of public health terminology will also be

created. Citation analyses of WHO materials in Russian will be produced.

146. Work to ensure that WHO’s information products are available in official and non-official

languages has continued. During the biennium 2016–2017, WHO Press authorized external partners

and regional offices to undertake 410 translations of 273 headquarters’ products into 58 languages

(five official and 53 non-official).

1 Document WHA61/2008/REC/1.

A71/41

29

147. WHO continues to offer a distance-learning language programme for the official languages of

the Organization, as well as for German and Portuguese.

148. During the biennium 2016–2017, WHO continued to publish the following serials with

multilingual content: Bulletin of the World Health Organization (English full text; abstracts in Arabic,

Chinese, French, Russian and Spanish); Eastern Mediterranean Health Journal (Arabic, English or

French full text; abstracts in Arabic, English and French); African Health Monitor (English, French or

Portuguese full text; abstracts in English, French and Portuguese); Public Health Panorama (English

and Russian); Weekly Epidemiological Record (English and French); Pan American Journal of Public

Health (English, Portuguese and Spanish); Western Pacific Surveillance and Response (Chinese and

English); WHO Drug Information (English, with International Nonproprietary Names in English,

French, Latin and Spanish).

= = =